40> VAV PRACTICE FORUM JOAN E. GOLDBERG
AIDS: SOCIAL WORK AND MANDATORY SCREENING Although much has been written about social work intervention in the acquired immune deficiency syndrome (AIDS) epidemic (Goldberg, 1989; Reamer, 1988; Ryan & Rowe, 1988), many believe that the AIDS cases recorded in the first visible decade of the epidemic, the 1980s, are only a small fraction of the cases that have yet to occur (Anderson & May, 1992). Although cases appear to be decreasing in the homosexual community in the 1990s, there is a spread of human immunodeficiency virus (HIV) infection occurring among drug users and heterosexuals (Anderson & May, 1992). As of September 1990, approximately 147,000 cases of AIDS had been reported to the Centers for Disease Control (CDC). Other recent figures suggest that as many as one in every 45 teenagers in the District of Columbia may already be infected with HIV (Goldstein, 1992). In view of these devastating figures, government and public health officials have been forced to consider ways to halt this epidemic. Ideas have included voluntary testing, mandatory screening, education, quarantine, and criminal punishment. This article focuses on the social justice issues involved in mandatory screening of HIV infection and argues from two social justice perspectives, utilitarian and Rawlsian, that mandatory screening for HIV infection is socially unjust and should not be supported by the social work profession.
308
MANDATORY SCREENING
Mandatory screening for HIV infection refers to the testing of individuals to discover whether they carry HIV antibodies. Public health officials have discussed both mandatory screening for specific groups within the population, such as has already occurred within the military and with blood donors, and the possibility of universal screening, which would include all individuals in society (Bauer, 1987; Fletcher, 1987). Proponents of mandatory screening for FIAT infection state that such testing will alert individuals who are infected and thus will reduce the spread of the virus and provide direct evidence of where and how the virus is spreading. They fear "that without broad testing . . . those people exposed will continue to spread the virus willy-nilly" (Woods, 1987, p. 35). However, there are many problems in seeking mandatory testing. For example, who will be tested? What will be done when someone tests positive? Can society force that person to inform his or her past, present, and future intimate acquaintances that he or she is seropositive? What happens with those who test false-negative or false-positive? Will there be mandatory follow-up? Opponents to mandatory screening see this course of action as a violation of individual liberties such as privacy, confidentiality, and autonomy and as an unnecessary method to
CCC Code: 0360-7283/92 $3.00 © 1992, National Association of Social Workers, Inc.
induce people to change behavior. They also fear that health and life insurance companies may use test results to screen applicants out of benefits (Cadwell, 1991). They fear that screening may succeed only in frightening people away from testing, treatment, or counseling and thus promote the spread of the virus. Bauer (1987) proposed universal mandatory testing as a way to avoid discrimination of certain groups because of race, sexual practice, and so forth. If a universal screening system is implemented, then everyone must agree to be tested and therefore everyone is treated equitably. Bauer further stated that those who oppose mandatory screening "consider AIDS as predominately an issue of rights" (p. 2) rather than an issue of public health. However, those who argued against Bauer stated that it is already known that universal testing is not the answer to protecting society because "mandatory or routine testing of other sexually transmitted diseases such as syphilis has been relatively ineffectual and over half the states in the U.S. have abandoned routine premarital screening on these grounds" (Osborn, 1987, p. 5). They argued that education of the general public, which would include risk groups, is where the government should be focusing its efforts and its finances. Mandatory HIV screening is a social justice issue. The ability to halt the spread of HIV infection involves people behaving justly in relation to each other. Mandatory screening is also viewed from a justice perspective because it will infringe on certain individuals' rights and liberties. Whenever an individual or a society devies the rights of another individual, the issue becomes one of social justice. Furthermore, those who argue for or against mandatory testing from a justice perspective need to clarify what is society's responsibility to protect its members. In an attempt to analyze the issue of mandatory screening from a social justice perspective, two different social justice theories, utilitarian and Rawlsian, are examined. UTILITARIANISM
Utilitarianism is a teleological, or consequentialist, theory. This means that it is concerned
with the ends or the consequences of actions, rules, or principles. Justice is viewed by what the end or consequence will be. Utilitarian justice purports that an action is right or just if it leads to the greatest possible balance of good consequences. The concepts of duty and right are subordinated to that which maximizes the good (Beauchamp, 1982). Utilitarianism further defines the Rood as happiness or satisfaction, independent of any account of what is morally right, and then defines the right as that which maximizes the good (Buchanan, 1981). There are various types of utilitarianism, but all attest that "the rightness and wrongness of actions and practices are determined solely by the consequences produced for the general well-being of all parties affected by actions or practices" (Beauchamp, 1982, p. 73). Many people in government and society who argue for mandatory screening argue from a utilitarian perspective. The public must be protected from further harm due to the spread of HIV infection. If, to protect the public, certain individuals may be harmed by mandatory testing, then this is the price society must pay. Mandatory testing is seen as a way to protect the public and is thus justified. It is a viewpoint that supports the majority and is not as concerned with the consequences to the minority. To support the utilitarian view of screening, one must have empirical data to support the thesis that the greatest good will be done by mandatory screening (Buchanan, 1981). Those who support mandatory screening use venereal disease as an example of mandatory screening that has halted the spread of disease. However, if one looks closely, most evidence does not support this fact. States such as New York have rescinded their statutes regarding venereal disease testing and marital licensing because they have become ineffectual (Collins, 1987). Besides, what would society do with a person who tests HIV seropositive and wants to marry? Until a treatment or cure is found, because someone who is HIV seropositive is so for life, does society deny this person the right to marry? This would be a gross infringement on that person's individual liberty and his or her constitutional rights.
AIDS: SOCIAL WORK AND MANDATORY SCREENING
309
Other problems include false-positive tests and people who test negative that may at a later date test positive. Should serial testing be mandated? Also, once a person tests positive, how can anyone be certain that that individual will notify his or her past, present, and future sexual partners? Will there be criminal procedures for those who do not practice safe sexual behavior? In supporting mandatory screening from a utilitarian perspective, one must be sure that no less-restrictive method is available to protect the public. Some argue from a utilitarian perspective that the public health is better protected by education, voluntary testing, and counseling. They are supported by data from health departments, hospital studies, and venereal disease clinics that indicate that voluntary and anonymous AIDS testing along with appropriate AIDS education and counseling does effect positive changes in high-risk sexual behavior (Woods, 1987). These data also indicate that "the incidence of new exposures to AIDS, syphilis, and gonorrhea among homosexuals . . . has decreased dramatically as a result" (Woods, 1987, p. 36). If these data prove true, then it is clear that mandatory screening would be unnecessarily restrictive and that the same benefits to the public may be obtained without mandatory screening. Another issue for discussion involves the denial of individual rights of liberty, autonomy, and freedom. A denial of these rights could not be justified if less-restrictive methods such as education or voluntary testing were available and effective against the spread of HIV infection. Utilitarians would also support the view that those whose rights would be infringed on by mandatory testing would have a "valid claim" on society to protect them. Mill (1859/1982), considered by many to be the father of utilitarianism, acknowledged that an act is unjust not only if it is wrong but also if it violates the rights of a particular person. An act is unjust if it interferes with "a valid claim on society to protect [a person] in the possession of [something], either by the force of law or by that of education and opinion" (Sher, 1979, p. xii). 310
Thus, the utilitarian argument that public officials put forth as a basis for mandatory screening for HIV infection cannot stand up to empirical evidence. It becomes clear that the denial of rights and civil liberties such as loss of job, housing, autonomy, and self-esteem are not warranted by virtue of the greater good because the greater good may be obtained by less-restrictive methods such as education and counseling. RAWLSIAN THEORY
John Rawls's theory of justice presents the social worker with another perspective from which to analyze the usefulness of mandatory screening. Rawls's theory was developed, in part, to find a better theory than utilitarianism to describe social justice. Rawls's theory of justice is a theory of distributive justice (Rawls, 1971). It is referred to as deontological (because of its concern with principles over consequences) rather than as teleological. It is concerned with justice as fairness and is also considered to represent a form of egalitarianism. For Rawlsian egalitarians, "the possession of humanity is the sole respect in which people are to be compared in determining the justice of distributions" (Beauchamp, 1982, p. 242). Rawls developed a hypothetical social contract procedure in which "valid principles of justice are those principles to which we would all agree if we could freely and impartially consider the social situation from a standpoint outside any actual society" (Beauchamp, 1982, p. 244). This position is referred to as the "original position." Rawls guaranteed that individuals are impartial under the "veil of ignorance." Under this veil, each person is unaware of his or her own characteristics such as sex, education, socioeconomic status, and so forth. Behind this veil, no person would be able to promote a principle that would in any way jeopardize himself or herself. It is believed that people behind the veil will adopt Rawls's two principles to protect themselves against unknown possibilities. These two principles of justice are lexically ordered: (1) Each person is to have an equal right to the
HEALTH & SOCIAL WORK / VOLUME 17, NUMBER 4 / NOVEMBER 1992
most extensive basic liberty compatible with a similar liberty for others, and (2) social and economic inequalities are to be arranged so that they are both reasonably expected to be to everyone's advantage and attached to positions and offices open to all (Rawls, 1971). The first part of the second principle is referred to as the "difference principle." It permits differences among individuals "so long as they are consistent with equal liberty and fair opportunity" (Beauchamp, 1982, p. 250). In this theory, unlike utilitarian theory, one can redistribute benefits to enhance the position of the "least advantaged person," or the person in society who has the least advantages. Rawls, in direct disagreement with utilitarianism, saw the need to "counteract inequalities caused purely by birth, natural endowment or historical circumstances" (Beauchamp, 1982, p. 252). Rawlsian theory, unlike utilitarianism, addresses the needs and rights of the less fortunate and is therefore more compatible with the value base of social work than utilitarianism appears to be. Mandatory screening would not be justified using this perspective because it takes away an individual's rights and liberties. Even if one argued for universal mandatory testing, a Rawlsian might argue that even in this situation, individual liberty is impinged on. Those who are already the least advantaged will suffer the most. Through screening, those who test HIV-positive may lose their job, their opportunities, their home, and thus their basic liberties because of the diagnosis. Thus, in dealing with basic rights, an individual arguing from a Rawlsian perspective would have to establish that the empirical evidence shows that the impingement of basic liberties is of more significance than are the results of mandatory screening, even if these basic liberties will only be denied to a few. Furthermore, although the difference principle permits inequalities of distribution to exist, these inequalities must be consistent with equal liberty and fair opportunity. Because there is empirical evidence that even voluntary testing has resulted in those who are already the least advantaged being denied equal lib-
erty and fair opportunity, one can surely predict that this would occur under any form of mandatory screening. CONCLUSION
Mandatory screening is unacceptable under either the utilitarian or Rawlsian principles of justice because one cannot prove that screening will protect the society, there is no way of using the results in an nondiscriminatory fashion, and individual autonomy and liberty will still be jeopardized. Therefore, social work as a profession must argue against mandatory screening for HIV infection. It is the hope of the future that successful treatment and a vaccine will become available to those already infected and not yet infected, respectively. Until that time, social workers have a responsibility to support policies that uphold the principles that are the bedrock of the social work profession: autonomy, confidentiality, equality, and social justice. A policy of mandatory screening would violate these principles and must not be supported. About the Author
Joan E. Goldberg, LCSW, BDC, 8303 Whittier Boulevard, Bethesda, MD 20817, is a doctoral candidate at Catholic University and in private practice in Washington, DC, and Bethesda, MD. References
Anderson, R., & May, R. (1992). Understanding the AIDS pandemic. Scientific American, 226(5), 58-67. Bauer, G. L. (1987). AIDS testing. AIDS & Public Policy Journal, 2(4), 2 4. Beauchamp, T. L. (1982). Philosophical ethics. New -
York: McGraw-Hill. Buchanan, T. L. (1981). Justice: A philosophical review. In E. Shelp (Ed.), Justice and health care
(pp. 3-21). New York: D. Reidel. Cadwell, S. (1991). Twice removed: The stigma suffered by gay men with AIDS. Smith College Studies in Social Work, 61, 236 246.
AIDS: SOCIAL WORK AND MANDATORY SCREENING
-
311
Collins, C. J. (1987). The case against AIDS testing. AIDS & Public Policy Journal, 2(4), 8-11. Fletcher, J. C. (1987). AIDS screening: A response to Gary Bauer. AIDS & Public Policy Journal, 2(4), 5-7. Goldberg, J. (1989). AIDS: Confidentiality and the social worker. In E. Judah & M. V. Joseph (Eds.), Ethics in contemporary social service: Theory and practice (pp. 116-127). Washington, DC: Catholic Charities USA. Goldstein, A. (1992, May 13). D.C. unveils antiAIDS campaign. Washington Post, p. 1. Mill, J. S. (1982). On liberty. New York: Penguin. (Original work published 1859)
Osborn, J. E. (1987). Widespread testing for AIDS: What is the question? AIDS & Public Policy Journal, 2(4), 3-4. Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press. Reamer, F. G. (1988). AIDS and ethics: The agenda for social workers. Social Work, 33, 460-464. Ryan, C., & Rowe, M. (1988). AIDS: Legal and ethica] issues. Social Casework, 69, 324-333. Sher, G. (Ed.). (1979). John Stuart Min: Utilitarianism. Indianapolis, IN: Hackett. Woods, G. (1987). The politics of AIDS testing. AIDS & Public Policy Journal, 2(4), 35-49. Accepted May 5, 1992
SOCIAL WORK ALMANAC by Leon Ginsberg "At last . . . an almanac especially for social workers! A copy should be on tbe desk of every social worker, and must be in the library of every social service agency." —Scott Briar, Director, Department of Social Work, Florida International University, Miami
n••
Social Work Almanac consolidates facts and presents them simply--to help you identify trends, substantiate reports, and prepare funding proposals. It's the most comprehensive compilation of statistica' social welfare data available in one source, containing entries on topics such as mental health, health and mortality, children, education, crime and delinquency, and social welfare. It also includes chapters on professional issues and basic demographic data on the U.S. population. 'es a book you shouldn't be without—and that's a simple fact! Send $32.95 (indudes $3.00 postage and handling) to NASW Distribution Center Item # 1964 P.O. Box 431 256 pages (estimated) NASW PRESS Annapolis JCT, MD 20701 $29.95 Or call 1 - 800 -227 - 3590 SWA4
312
HEALTH & SOCIAL WORK / VOLUME 17, NUMBER 4 / NOVEMBER 1992
AIDS: SOCIAL WORK AND MANDATORY SCREENING Although much has been written about social work intervention in the acquired immune deficiency syndrome (AIDS) epidemic (Goldberg, 1989; Reamer, 1988; Ryan & Rowe, 1988), many believe that the AIDS cases recorded in the first visible decade of the epidemic, the 1980s, are only a small fraction of the cases that have yet to occur (Anderson & May, 1992). Although cases appear to be decreasing in the homosexual community in the 1990s, there is a spread of human immunodeficiency virus (HIV) infection occurring among drug users and heterosexuals (Anderson & May, 1992). As of September 1990, approximately 147,000 cases of AIDS had been reported to the Centers for Disease Control (CDC). Other recent figures suggest that as many as one in every 45 teenagers in the District of Columbia may already be infected with HIV (Goldstein, 1992). In view of these devastating figures, government and public health officials have been forced to consider ways to halt this epidemic. Ideas have included voluntary testing, mandatory screening, education, quarantine, and criminal punishment. This article focuses on the social justice issues involved in mandatory screening of HIV infection and argues from two social justice perspectives, utilitarian and Rawlsian, that mandatory screening for HIV infection is socially unjust and should not be supported by the social work profession.
308
MANDATORY SCREENING
Mandatory screening for HIV infection refers to the testing of individuals to discover whether they carry HIV antibodies. Public health officials have discussed both mandatory screening for specific groups within the population, such as has already occurred within the military and with blood donors, and the possibility of universal screening, which would include all individuals in society (Bauer, 1987; Fletcher, 1987). Proponents of mandatory screening for FIAT infection state that such testing will alert individuals who are infected and thus will reduce the spread of the virus and provide direct evidence of where and how the virus is spreading. They fear "that without broad testing . . . those people exposed will continue to spread the virus willy-nilly" (Woods, 1987, p. 35). However, there are many problems in seeking mandatory testing. For example, who will be tested? What will be done when someone tests positive? Can society force that person to inform his or her past, present, and future intimate acquaintances that he or she is seropositive? What happens with those who test false-negative or false-positive? Will there be mandatory follow-up? Opponents to mandatory screening see this course of action as a violation of individual liberties such as privacy, confidentiality, and autonomy and as an unnecessary method to
CCC Code: 0360-7283/92 $3.00 © 1992, National Association of Social Workers, Inc.
induce people to change behavior. They also fear that health and life insurance companies may use test results to screen applicants out of benefits (Cadwell, 1991). They fear that screening may succeed only in frightening people away from testing, treatment, or counseling and thus promote the spread of the virus. Bauer (1987) proposed universal mandatory testing as a way to avoid discrimination of certain groups because of race, sexual practice, and so forth. If a universal screening system is implemented, then everyone must agree to be tested and therefore everyone is treated equitably. Bauer further stated that those who oppose mandatory screening "consider AIDS as predominately an issue of rights" (p. 2) rather than an issue of public health. However, those who argued against Bauer stated that it is already known that universal testing is not the answer to protecting society because "mandatory or routine testing of other sexually transmitted diseases such as syphilis has been relatively ineffectual and over half the states in the U.S. have abandoned routine premarital screening on these grounds" (Osborn, 1987, p. 5). They argued that education of the general public, which would include risk groups, is where the government should be focusing its efforts and its finances. Mandatory HIV screening is a social justice issue. The ability to halt the spread of HIV infection involves people behaving justly in relation to each other. Mandatory screening is also viewed from a justice perspective because it will infringe on certain individuals' rights and liberties. Whenever an individual or a society devies the rights of another individual, the issue becomes one of social justice. Furthermore, those who argue for or against mandatory testing from a justice perspective need to clarify what is society's responsibility to protect its members. In an attempt to analyze the issue of mandatory screening from a social justice perspective, two different social justice theories, utilitarian and Rawlsian, are examined. UTILITARIANISM
Utilitarianism is a teleological, or consequentialist, theory. This means that it is concerned
with the ends or the consequences of actions, rules, or principles. Justice is viewed by what the end or consequence will be. Utilitarian justice purports that an action is right or just if it leads to the greatest possible balance of good consequences. The concepts of duty and right are subordinated to that which maximizes the good (Beauchamp, 1982). Utilitarianism further defines the Rood as happiness or satisfaction, independent of any account of what is morally right, and then defines the right as that which maximizes the good (Buchanan, 1981). There are various types of utilitarianism, but all attest that "the rightness and wrongness of actions and practices are determined solely by the consequences produced for the general well-being of all parties affected by actions or practices" (Beauchamp, 1982, p. 73). Many people in government and society who argue for mandatory screening argue from a utilitarian perspective. The public must be protected from further harm due to the spread of HIV infection. If, to protect the public, certain individuals may be harmed by mandatory testing, then this is the price society must pay. Mandatory testing is seen as a way to protect the public and is thus justified. It is a viewpoint that supports the majority and is not as concerned with the consequences to the minority. To support the utilitarian view of screening, one must have empirical data to support the thesis that the greatest good will be done by mandatory screening (Buchanan, 1981). Those who support mandatory screening use venereal disease as an example of mandatory screening that has halted the spread of disease. However, if one looks closely, most evidence does not support this fact. States such as New York have rescinded their statutes regarding venereal disease testing and marital licensing because they have become ineffectual (Collins, 1987). Besides, what would society do with a person who tests HIV seropositive and wants to marry? Until a treatment or cure is found, because someone who is HIV seropositive is so for life, does society deny this person the right to marry? This would be a gross infringement on that person's individual liberty and his or her constitutional rights.
AIDS: SOCIAL WORK AND MANDATORY SCREENING
309
Other problems include false-positive tests and people who test negative that may at a later date test positive. Should serial testing be mandated? Also, once a person tests positive, how can anyone be certain that that individual will notify his or her past, present, and future sexual partners? Will there be criminal procedures for those who do not practice safe sexual behavior? In supporting mandatory screening from a utilitarian perspective, one must be sure that no less-restrictive method is available to protect the public. Some argue from a utilitarian perspective that the public health is better protected by education, voluntary testing, and counseling. They are supported by data from health departments, hospital studies, and venereal disease clinics that indicate that voluntary and anonymous AIDS testing along with appropriate AIDS education and counseling does effect positive changes in high-risk sexual behavior (Woods, 1987). These data also indicate that "the incidence of new exposures to AIDS, syphilis, and gonorrhea among homosexuals . . . has decreased dramatically as a result" (Woods, 1987, p. 36). If these data prove true, then it is clear that mandatory screening would be unnecessarily restrictive and that the same benefits to the public may be obtained without mandatory screening. Another issue for discussion involves the denial of individual rights of liberty, autonomy, and freedom. A denial of these rights could not be justified if less-restrictive methods such as education or voluntary testing were available and effective against the spread of HIV infection. Utilitarians would also support the view that those whose rights would be infringed on by mandatory testing would have a "valid claim" on society to protect them. Mill (1859/1982), considered by many to be the father of utilitarianism, acknowledged that an act is unjust not only if it is wrong but also if it violates the rights of a particular person. An act is unjust if it interferes with "a valid claim on society to protect [a person] in the possession of [something], either by the force of law or by that of education and opinion" (Sher, 1979, p. xii). 310
Thus, the utilitarian argument that public officials put forth as a basis for mandatory screening for HIV infection cannot stand up to empirical evidence. It becomes clear that the denial of rights and civil liberties such as loss of job, housing, autonomy, and self-esteem are not warranted by virtue of the greater good because the greater good may be obtained by less-restrictive methods such as education and counseling. RAWLSIAN THEORY
John Rawls's theory of justice presents the social worker with another perspective from which to analyze the usefulness of mandatory screening. Rawls's theory was developed, in part, to find a better theory than utilitarianism to describe social justice. Rawls's theory of justice is a theory of distributive justice (Rawls, 1971). It is referred to as deontological (because of its concern with principles over consequences) rather than as teleological. It is concerned with justice as fairness and is also considered to represent a form of egalitarianism. For Rawlsian egalitarians, "the possession of humanity is the sole respect in which people are to be compared in determining the justice of distributions" (Beauchamp, 1982, p. 242). Rawls developed a hypothetical social contract procedure in which "valid principles of justice are those principles to which we would all agree if we could freely and impartially consider the social situation from a standpoint outside any actual society" (Beauchamp, 1982, p. 244). This position is referred to as the "original position." Rawls guaranteed that individuals are impartial under the "veil of ignorance." Under this veil, each person is unaware of his or her own characteristics such as sex, education, socioeconomic status, and so forth. Behind this veil, no person would be able to promote a principle that would in any way jeopardize himself or herself. It is believed that people behind the veil will adopt Rawls's two principles to protect themselves against unknown possibilities. These two principles of justice are lexically ordered: (1) Each person is to have an equal right to the
HEALTH & SOCIAL WORK / VOLUME 17, NUMBER 4 / NOVEMBER 1992
most extensive basic liberty compatible with a similar liberty for others, and (2) social and economic inequalities are to be arranged so that they are both reasonably expected to be to everyone's advantage and attached to positions and offices open to all (Rawls, 1971). The first part of the second principle is referred to as the "difference principle." It permits differences among individuals "so long as they are consistent with equal liberty and fair opportunity" (Beauchamp, 1982, p. 250). In this theory, unlike utilitarian theory, one can redistribute benefits to enhance the position of the "least advantaged person," or the person in society who has the least advantages. Rawls, in direct disagreement with utilitarianism, saw the need to "counteract inequalities caused purely by birth, natural endowment or historical circumstances" (Beauchamp, 1982, p. 252). Rawlsian theory, unlike utilitarianism, addresses the needs and rights of the less fortunate and is therefore more compatible with the value base of social work than utilitarianism appears to be. Mandatory screening would not be justified using this perspective because it takes away an individual's rights and liberties. Even if one argued for universal mandatory testing, a Rawlsian might argue that even in this situation, individual liberty is impinged on. Those who are already the least advantaged will suffer the most. Through screening, those who test HIV-positive may lose their job, their opportunities, their home, and thus their basic liberties because of the diagnosis. Thus, in dealing with basic rights, an individual arguing from a Rawlsian perspective would have to establish that the empirical evidence shows that the impingement of basic liberties is of more significance than are the results of mandatory screening, even if these basic liberties will only be denied to a few. Furthermore, although the difference principle permits inequalities of distribution to exist, these inequalities must be consistent with equal liberty and fair opportunity. Because there is empirical evidence that even voluntary testing has resulted in those who are already the least advantaged being denied equal lib-
erty and fair opportunity, one can surely predict that this would occur under any form of mandatory screening. CONCLUSION
Mandatory screening is unacceptable under either the utilitarian or Rawlsian principles of justice because one cannot prove that screening will protect the society, there is no way of using the results in an nondiscriminatory fashion, and individual autonomy and liberty will still be jeopardized. Therefore, social work as a profession must argue against mandatory screening for HIV infection. It is the hope of the future that successful treatment and a vaccine will become available to those already infected and not yet infected, respectively. Until that time, social workers have a responsibility to support policies that uphold the principles that are the bedrock of the social work profession: autonomy, confidentiality, equality, and social justice. A policy of mandatory screening would violate these principles and must not be supported. About the Author
Joan E. Goldberg, LCSW, BDC, 8303 Whittier Boulevard, Bethesda, MD 20817, is a doctoral candidate at Catholic University and in private practice in Washington, DC, and Bethesda, MD. References
Anderson, R., & May, R. (1992). Understanding the AIDS pandemic. Scientific American, 226(5), 58-67. Bauer, G. L. (1987). AIDS testing. AIDS & Public Policy Journal, 2(4), 2 4. Beauchamp, T. L. (1982). Philosophical ethics. New -
York: McGraw-Hill. Buchanan, T. L. (1981). Justice: A philosophical review. In E. Shelp (Ed.), Justice and health care
(pp. 3-21). New York: D. Reidel. Cadwell, S. (1991). Twice removed: The stigma suffered by gay men with AIDS. Smith College Studies in Social Work, 61, 236 246.
AIDS: SOCIAL WORK AND MANDATORY SCREENING
-
311
Collins, C. J. (1987). The case against AIDS testing. AIDS & Public Policy Journal, 2(4), 8-11. Fletcher, J. C. (1987). AIDS screening: A response to Gary Bauer. AIDS & Public Policy Journal, 2(4), 5-7. Goldberg, J. (1989). AIDS: Confidentiality and the social worker. In E. Judah & M. V. Joseph (Eds.), Ethics in contemporary social service: Theory and practice (pp. 116-127). Washington, DC: Catholic Charities USA. Goldstein, A. (1992, May 13). D.C. unveils antiAIDS campaign. Washington Post, p. 1. Mill, J. S. (1982). On liberty. New York: Penguin. (Original work published 1859)
Osborn, J. E. (1987). Widespread testing for AIDS: What is the question? AIDS & Public Policy Journal, 2(4), 3-4. Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press. Reamer, F. G. (1988). AIDS and ethics: The agenda for social workers. Social Work, 33, 460-464. Ryan, C., & Rowe, M. (1988). AIDS: Legal and ethica] issues. Social Casework, 69, 324-333. Sher, G. (Ed.). (1979). John Stuart Min: Utilitarianism. Indianapolis, IN: Hackett. Woods, G. (1987). The politics of AIDS testing. AIDS & Public Policy Journal, 2(4), 35-49. Accepted May 5, 1992
SOCIAL WORK ALMANAC by Leon Ginsberg "At last . . . an almanac especially for social workers! A copy should be on tbe desk of every social worker, and must be in the library of every social service agency." —Scott Briar, Director, Department of Social Work, Florida International University, Miami
n••
Social Work Almanac consolidates facts and presents them simply--to help you identify trends, substantiate reports, and prepare funding proposals. It's the most comprehensive compilation of statistica' social welfare data available in one source, containing entries on topics such as mental health, health and mortality, children, education, crime and delinquency, and social welfare. It also includes chapters on professional issues and basic demographic data on the U.S. population. 'es a book you shouldn't be without—and that's a simple fact! Send $32.95 (indudes $3.00 postage and handling) to NASW Distribution Center Item # 1964 P.O. Box 431 256 pages (estimated) NASW PRESS Annapolis JCT, MD 20701 $29.95 Or call 1 - 800 -227 - 3590 SWA4
312
HEALTH & SOCIAL WORK / VOLUME 17, NUMBER 4 / NOVEMBER 1992
